OK, dementia is such a huge topic that once I get started on it, I always think of “one more thing…”! So, as a follow up to my last blog post where I elaborated on the various forms of dementia, here’s my latest, “one more thing”….

What should you consider doing when you observe the very first sign of memory loss in an elder loved one; if you receive a formal diagnosis of dementia from a gerontology focused medical professional? Remember, dementia’s are regressive chronic illnesses. The memory loss will continue at an unknown and unpredictable rate.

If you are like so many families there has been minimal, if any, discussions on what to do in case your elderly loved ones becomes incapacitated. At the advent of cognitive deficiencies, this is a conversation that has to take place immediately. You can no longer allow your elder loved one to think of themselves as totally independent and self-sustaining. In many cases, it takes a jolt, such as a dire medical diagnosis, to motivate seniors to have ‘the talk’; cooperating and sharing in the details of their financial assets along with their explicit wishes for how they want their affairs handled. In any event, you have to move into a ‘managed care’ mindset with deliberate immediacy. Think “Assets” and “Advanced Directives”!

If there are siblings, a determination must be made regarding who will be the designated individual(s) for financial and medical related issues. If you are lucky, the senior will make this choice, thereby eliminating any debate or heated fellowship between siblings. These issues can be quite contentious in some families.

ASSETS — Without fail, make sure that the assets of your loved ones are not solely in their name. Working together compile a complete list of each and every, bank accounts, investment accounts, mortgage, deed, insurance policies etc… Become the designee on bank accounts, mortgages, etc… Remember, if there is a another person legally on the account that individual has access to the asset. You can also use a ‘beneficiary’ designation on these assets whereby upon death, the designated person has access to the asset.

PASSWORDS — Don’t forget about electronic access from sources such as bank accounts to websites such as Amazon. Identify and document everything.

Now, let’s talk about Advanced Directives.

ADVANCED DIRECTIVES — Legal documents that allow you to plan your own end-of-life wishes known in the event that you are unable to communicate those thoughts later.

Living Will — An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, is a set of written instructions that a person gives that specify what actions should be taken for their health, if they are no longer able to make decisions because of illness or incapacity. A living will is one form of advance directive, leaving instructions for treatment. The living will is the oldest form of advanced directive. A living will usually provides specific directives about the course of treatment that is to be followed by health care providers and caregivers. In some cases a living will may forbid the use of various kinds of burdensome medical treatment. It may also be used to express wishes about the use or foregoing of food and water, if supplied via tubes or other medical devices. The living will is used only if the individual has become unable to give informed consent or refusal due to incapacity. A living will can be very specific or very general. Consider the ‘living will’ as the fundamental building block of a comprehensive advance directive plan. But advanced directives have evolved well beyond the living will.

Power of Attorney or Health Care Proxy — The next layer of the advanced directives foundation is the power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf should ever be rendered incapable of making their wishes known. This may or may not be the same person selected for financial responsibility. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care. The appointed health care proxy has, in essence, the same rights to request or refuse treatment that the individual would have if still capable of making and communicating health care decisions. The primary benefit of this second layer of advance directives is that the appointed representative can make real-time decisions in actual circumstances, as opposed to advance decisions framed in hypothetical situations, as recorded in a living will.

Medical Directive — The next widely recognized third layer advance directive is the Medical Directive. This is usually a six-page document that provides six case scenarios for advance medical decision-making. The scenarios are each associated with a roster of commonly considered medical procedures and interventions, allowing the individual to decide in advance which treatments are wanted or not wanted under the circumstances.

TAKE ACTION NOW!

So there you have it. A comprehensive approach you should action, ideally before a crisis occurs, to assure that the wishes of your elder loved ones are fulfilled. Using these tools helps to assure that there are few unknown issues regarding money and finance, property, or specific medical care requests. Although there are do-it-yourself options available, I strongly recommend working with an attorney that has a practice in estate law or eldercare to prepare and file the documents. Mistakes in the paperwork can prove to be frustrating and costly at a time when you need as much calm, order, and predictability as possible.

April 16th is National Health Care Decisions day. It’s the date set aside each year to encourage everybody over age 18 to discuss and plan ahead of a serious illness. I encourage everyone to do just that. This is not a subject of exclusively for seniors. As the commercial goes “…life happens fast”! Completing advanced directives should be a requirement for everyone once we reach the age when we are considered an adult. Once completed, the documents should be reviewed every 24-months to remain consistent with the personal wishes that may change as we go through life. If you haven’t done so already, use April 16th as a day of action and complete your Advance Directives. Your loved ones will be glad you did.

A few weeks ago, an associate of mine was speaking to me about their parent’s increasingly noticeable memory loss issues. We spoke about possible causes that excluded dementia. I think it’s important not to jump to any conclusions. There are a number of reasons that a senior might experience short-term memory impairment. I also told him to see a gerontology doctor for an assessment. Because I have blogged a good deal about dementia, I also told her that she might reference my blog postings focused on the category of “dementia” and “Alzheimer’s” for further background. Her mom’s diagnosis reminded me that I had not blogged about the various types of dementia that exist. We spend so much time focused on “Alzheimer’s” dementia. In fact, we seem to call all memory related issues in seniors “Alzheimer’s”, just as we used to refer this state very broadly as “senility”. So here is my ‘deeper dive’; a non-clinical overview of the more prominent variations of the diseases generalized by the term “dementia”.

DEMENTIA

Dementia is “a usually progressive condition marked by deteriorated cognitive functioning often with emotional apathy.” The cause of dementia is a brain dysfunction which disrupts the thought process and perception. There are actually two types of dementia: reversible and irreversible. Reversible dementia is brought on by a disease or a condition such as an infection, intoxication, depression, a reaction to medication(s), heart or lung problems and other disorders that may deprive the brain of oxygen. This is why I talked with my associate about the causes of dementia. Most of us immediately associate dementia with irreversible dementia. Irreversible dementia is characterized by a pathological disease that is progressive with no other cause identified. With over 5 million people over the age of 65 experiencing Alzheimer dementia, this form of the disease is by far, the version that is diagnosed the most.

But, as I stated in the introduction of this blog post, I wanted to introduce the other, somewhat less prevalent forms of dementia.

Vascular Dementia — Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain. You can develop vascular dementia after a stroke blocks an artery in your brain, but strokes don’t always cause vascular dementia. Whether a stroke affects your thinking and reasoning depends on your stroke’s severity and location. Vascular dementia also can result from other conditions that damage blood vessels and reduce circulation, depriving your brain of vital oxygen and nutrients. Factors that increase your risk of heart disease and stroke — including high blood pressure, high cholesterol and smoking — also raise your vascular dementia risk. Controlling these factors can help lower your chances of developing vascular dementia.

Dementia with Lewy Bodies (DLB) — DLB affects an estimated 1.3 million individuals and their families in the United States. Because LBD symptoms can closely resemble other more commonly known diseases like Alzheimer’s and Parkinson’s, it is currently widely underdiagnosed. Many doctors or other medical professionals still are not familiar with LBD. LBD is an umbrella term for two related diagnoses. LBD refers to both Parkinson’s disease dementia and dementia with Lewy bodies. The earliest symptoms of these two diseases differ, but reflect the same underlying biological changes in the brain. Over time, people with both diagnoses will develop very similar cognitive, physical, sleep, and behavioral symptoms. While it may take more than a year or two for enough symptoms to develop for a doctor to diagnose LBD, it is critical to pursue a formal diagnosis. Early diagnosis allows for important early treatment that may extend quality of life and independence

Frontotemporo Dementia (FTD) — FTD is a neurodegenerative disease characterized by severe frontotemporal lobar degeneration. The disorder was first identified in 1994 by Kirk Wilhelmsen and colleagues, who distinguished it from Alzheimer’s disease and Lewy body dementia based on the fact that it did not manifest with amyloid plaques, neurofibrillary tangles, or Lewy bodies.[1] Second only to Alzheimer’s disease (AD) in prevalence, FTD accounts for 20% of pre-senile dementia cases.[2] Symptoms can begin to appear on average around 45 to 65 years of age, regardless of gender.[2] The most common symptoms include significant changes in social and personal behavior, as well as a general blunting of emotions. Currently, there is no cure to FTD, but there are treatment options available that help alleviate the symptoms.

Binswanger’s Dementia — Binswanger’s disease (BD), also called subcortical vascular dementia, is a type of dementia caused by widespread, microscopic areas of damage to the deep layers of white matter in the brain. The damage is the result of the thickening and narrowing (atherosclerosis) of arteries that feed the subcortical areas of the brain. Atherosclerosis (commonly known as “hardening of the arteries”) is a systemic process that affects blood vessels throughout the body. It begins late in the fourth decade of life and increases in severity with age. As the arteries become more and more narrowed, the blood supplied by those arteries decreases and brain tissue dies. A characteristic pattern of Binswanger’s disease-damaged brain tissue can be seen with modern brain imaging techniques such as CT scans or magnetic resonance imaging (MRI)

Parkinson’s Disease — Parkinson’s disease is a progressive disorder of the nervous system that affects your movement. It typically starts between the age of fifty and sixty. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But while a tremor may be the most well-known sign of Parkinson’s disease, the disorder also commonly causes stiffness or slowing of movement. In the early stages of Parkinson’s disease, your face may show little or no expression or your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson’s disease symptoms worsen as your condition progresses over time. Although Parkinson’s disease can’t be cured, medications may markedly improve your symptoms. In occasional cases, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms.

So there you have it! Just a bit more information to make you aware of that there are various types of dementia. Alzheimer’s is by far, the most diagnosed form of dementia followed by Frontotemporo Dementia (FTD). I you find this information useful and that it adds to your knowledge base.

It’s rare, but today, this fourth day of the new year, I saw a weather posting stating that northeast Ohio is under a ‘winter storm watch’…that lasts 4 days. I just don’t see that very often. During this 4-day period, lows could reach -10oF and high temperatures will reach no more than 34oF, and often not higher than 15oF. This, in addition to the forecast that this winter is predicted to be colder than those of recent past, necessitated the need for me to request that we all pay additional attention to senior citizens this time of the year.

We should all be particularly vigilant at times like this. Make it a point to check on the seniors you know on a regular basis to assure that they are alright. Remember, seniors often mask their reality; many just do not like to ask for assistance or admit that they are having trouble or that they need help. Furnaces can fail, pipes can burst, all of these can cause a senior to ‘hunker down’ rather than reach out. My parents furnace failed this past November, and all I heard was about how they survived the winters of the great depression with little or no heat. The implication is that they can employ the same tactics they learned in their youth. The key is “in their youth” when they were much more adaptable to extremes. Now as seniors, cold weather and lack of working equipment is a far more complex issue that often ends badly. I had their furnace completely replaced and added an air conditioning unit all within 48-hours. Now with the cold weather in it’s apex, it is extremely difficult to get fast service from an HVAC service person.

Keep in mind that those over the age of 65 account for nearly half of all hypothermia deaths. As the body ages, the ability to maintain a normal internal body temperature decreases, creating an insensitivity to moderately cold temperatures. Seniors may not realize they are putting themselves at risk until symptoms appear.

Symptoms of hypothermia include: shivering, exhaustion, confusion, fumbling hands, memory loss, slurred speech and drowsiness. If symptoms are present, immediate medical attention is necessary. The leading reason for hypothermia in the elderly is due to poorly heated homes, which is entirely preventable. Follow these simple tips to ensure a warm household.

Keep Warm

• Keep the thermostat at 65 degrees, at least. Consistently check it to make sure your home is sufficiently warm. Even as heating costs rise, your safety should be a priority.

• Put a carbon monoxide detector near where you sleep.

• Ensure that there is adequate insulation, and check and clean the fireplace and furnace. Furnace filters should be replaced monthly.

• Be careful with space heaters, kerosene heaters, and gas stoves. This equipment is often used as a ‘Plan B’ if the furnace fails. They can be dangerous if flammable objects come in close proximity. Also, for some seniors, these are their primary heating units. This is a very dangerous practice but we have to face the reality that some of our seniors live with everyday. Moreover, we have to be aware of these realities and provide whatever assistance we can in a timely fashion that avoids disastrous outcomes. If a fireplace is being used, make sure the flue is open and clear.

• Minimize drafts by filling old socks with sand and using them in drafty windowsills and door jams. Weather-strip around windows and doors. Keep doors to unused rooms closed and close curtains at night.

• Add an extra blanket to the bed and warm the bed in advance with a hot water bottle. Never use an electric blanket – it may be difficult to operate the controls if the temperature needs to be adjusted in the night.

• Dress in layers of loose fitting clothing. If you go outside, make sure your head is covered.

Every year, more than 1.6 million seniors end up in the emergency room because of a fall. With icy conditions, the chances of falling are even greater.

Preventing Falls

• Take a couple minutes per day and stretch your limbs in order to loosen muscles.

• Stay inside – make arrangements for someone to shovel and salt driveways and walkways. Professional caregivers can assist with to-do items, such as bringing in the mail and/or picking up groceries.

• Wear shoes or boots with a non-skid sole.

• Have handrails installed on outside walls for frequently used walkways.

• If a senior you know uses a cane or walker, check the rubber tips to make sure they are not worn smooth. Try to accompany them when they have to go outdoors in snow and/or icy conditions.

Winter weather can take a toll on everyone, especially seniors. Seasonal affective disorder (SAD) can occur in seniors and impact their emotional health. Some signs to watch for with SAD include: a loss of energy, an increased appetite and an enhanced feeling of lethargy and tiredness. If symptoms are present, talk to your medical provider about treatment options.

Additionally, winter storms can be unpredictable. It is important to be prepared in case of an emergency.

A Functional Network

• Stay in touch in with family, friends and neighbors. Schedule phone calls, or enlist the help of a professional caregiver to come in with some degree of regularity. Don’t count on a senior to call you; make it a point to call them even if they don’t regularly reciprocate.

• Make arrangements for assistance in case of a blizzard or power outage. Keep important numbers in an emergency kit, along with non-perishable foods, water and medications.

• Many seniors have landlines. If the power goes out or the phone lines go down due to ice/snow buildup, their landline may not work. Buy and maintain a mobile phone such as a senior friendly JitterBug, to contact your network if the power is out and the landline does not work.

This is just a short checklist. I urge you to extend yourself to our elder neighbors and friends during this first calendar quarter of 2014. Let’s make sure they do not become unnecessary victims to the inclement weather of the season.

I hope you all have a great 2014. Remember, to extend yourself to help a senior!

The end of another year has arrived. I’d like to reference you to my post from one year ago, December 2012, titled Home for the Holidays! The focus of that post was indicators that you might look for during a visit with your aging loved ones. The information posted there remains relevant and I plan to reference it as appropriate going forward.

For many, the holidays are the best time of the year filled with family get-togethers, feasts and fun traditions; but for seniors, this can be the most depressing of all seasons as they pine for lost loved ones. And in a lot of cases, with family hundreds of miles away, seniors struggle to decorate, shop, prepare a meal and start to feel sad that they can’t move around like they did when they were younger.

Here at Visiting Angels, we offer families the vital service of hiring senior loved ones a holiday companion. Don’t know what to get Grandma or Grandpa for Christmas? How about a friend or better yet an angel — a Visiting Angel that is! A holiday companion is also a priceless gift that adult children can give themselves this year. Visiting Angels can provide them with an angel to tend to their senior loved ones’ every need as they prepare for a house full of guests or holiday event.

According to 2005 research from the University of Michigan, roughly 1 in 4 seniors (age 65 or older) suffers from depression. More than 70 percent of older Americans feel isolated and lonely. And per the Administration on Aging (2010 data) nearly one-third of all non-institutionalized older Americans live alone. “The holidays can be tough on seniors because many have lost people they loved. Plus, they aren’t as mobile to visit friends and family or even decorate or shop,” says Larry Meigs, CEO of Visiting Angels. “Our caregivers socialize with seniors, take them visiting and keep them engaged instead of sitting at home feeling isolated and depressed. Plus, our caregivers give families the heads up about their senior’s state-of-mind, to differentiate between the holiday blues and full blown depression.”

We wish you and your family peace and happiness throughout the holiday season. The safety and well-being of our loved-ones is always a concern for all of us – regardless of what time of year! If we can be of assistance in answering questions or providing caregiving services, please don’t hesitate to contact us via the web link on the right panel of this page, or give our office a call at 216.231.6400.

I do hope that 2013 has been a great year for you. As for Visiting Angels, 2013 was another good year of helping the aging seniors age-in-place with as much independence and grace as possible. We thank our clients for the opportunity to serve and help so many seniors with their activities of daily living and providing them with companionship to help them at any time and especially at this time of the year.

November is National Alzheimer’s Disease Awareness Month and also National Caregiver Month. In the United States, there are more than 15 million Alzheimer’s and dementia caregivers. I’ve posted a number of blogs on this subject over the past few years regarding dementia and specifically Alzheimer’s, the most frequently diagnosed type of dementia. You can perform a ‘search’ of this site and find perhaps five or six topic related postings. Often from personal experience, we know how bad Alzheimer’s disease is for the individual that suffers from it and from the perspective of the caregivers involved in patient care. But do you know what the early symptoms are? With the arrival of baby boomers to retirement age, there is increasing investments in Alzheimer’s research for a cure. There are more and more medicines making their way to the market that slow the progression of the disease. Early detection is becoming more important to the successfully managing Alzheimer’s dementia. Keep these 10 warning signs of Alzheimer’s in mind.

Memory Loss That Disrupts Daily Life — One of the most common signs of Alzheimer’s, observe whether an individual is repeatedly asking for the same information.

Challenges in Planning of Solving Problems — You may observe that an individual is having difficulty concentrating and may take much longer to do things than they did in the past.

Difficulty Completing Familiar Tasks at Home, at Work, or at Leisure — Suddenly, people may have trouble driving to a familiar location, or remembering rules to a familiar process or even a game.

Confusion with Time or Place — An individual may forget where they are or how they got there.

New Problems with Words in Speaking or Writing — An individual may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name.

Misplacing Things and Losing the Ability to Retrace Steps — Look for a pattern of placing things in unusual places. They may lose things and be unable to go back over their steps to find the again. They may also accuse others of stealing.

Decreased or Poor Judgment — Look for negative changes in grooming or keeping themselves clean. You may also see changes or just poor judgment when dealing with money and with sales people either over the phone or face-to-face.

Withdrawal from Work or Social Activities — They understand that something is changing and may begin to avoid being social. They may start to pull back from hobbies, or social activities.

Changes in Mood and Personality — They may become confused, suspicious, depressed, fearful or anxious. They be easily upset at home, at work, with friends or in places where they are out of their comfort zone.

Now make sure to compare and contrast the Alzheimer’s Dementia early warning signs above with the following signs that most of us experience. These signs are simply typical of age-related changes.

Sometimes forgetting names or appointments, but remembering them later.

Making occasional errors when balancing a checkbook.

Occasionally needing help to use the settings on a microwave or to record a television show.

Getting confused about the day of the week but figuring it out later.

Vision changes related to cataracts.

Sometimes having trouble finding the right word.

Misplacing things from time-to-time and retracing steps to find them.

Making a bad decision once in a while.

Sometime feeling weary of work, family and social obligations.

Developing very specific ways of doing things and becoming irritable when a routine is disrupted.